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In Harish Rana vs Union of India, a Bench of two Judges of the Supreme Court held that Clinically Assisted Nutrition and Hydration (CANH) given through a PEG tube is medical treatment, and that withdrawing it was in the best interests of a young man who had been in a permanent vegetative state for 13 years. Both the primary and the secondary medical boards had certified this, and his parents and siblings agreed. The Court directed that his medical treatment, including CANH, be withdrawn or withheld through a palliative and end of life care plan at AIIMS, and it gave nationwide directions to make the Common Cause guidelines work in practice.
Can medical treatment such as CANH through a PEG tube be withdrawn from a patient in a permanent vegetative state in India?
Yes, in the way and under the safeguards the Court explains. The Court held that CANH is medical treatment and that its continuation was not in Harish Rana's best interests, because the treatment had become prolonged and futile with no hope of recovery. Both medical boards and his family reached the same view. It directed that his medical treatment, including CANH, be withdrawn and/or withheld through a palliative and end of life care plan at AIIMS, New Delhi. Active euthanasia remains impermissible.
Result: the Miscellaneous Application is disposed of with directions. Justice Viswanathan agreed and wrote a separate concurring opinion.
Case Details
- Case number
- Miscellaneous Application No. 2238 of 2025 in Special Leave Petition (Civil) No. 18225 of 2024
- Diary number
- 60980/2025
- Date of judgment
- 11 March 2026
- Neutral citation
- 2026 INSC 222
- Bench
- Justice J.B. Pardiwala and Justice K.V. Viswanathan
- Judgment written by
- Justice J.B. Pardiwala. Justice K.V. Viswanathan wrote a separate concurring opinion
- Opinions
- Two opinions, and the Bench agrees on the result
- Arising from
- Writ Petition (Civil) No. 4927 of 2024 in the Delhi High Court, dismissed by an order dated 2 July 2024. The Special Leave Petition against it was disposed of on 8 November 2024 with liberty to move the Court again
- Main laws
- Article 21 and Article 226 of the Constitution, and the guidelines in Common Cause vs Union of India (2018) as modified in 2023
- Status
- Reportable
Case Journey: How It Reached the Supreme Court
- 1Accident and years of careOn 20 August 2013 Harish Rana falls from the fourth floor of his paying guest accommodation and suffers a diffuse axonal injury. He is treated at PGI Chandigarh and then at hospitals in New Delhi, and is cared for largely at home on a tracheostomy, a urinary catheter and CANH through a PEG tube.
- 2The courts so farThe Delhi High Court dismisses his writ petition on 2 July 2024. The Special Leave Petition is disposed of on 8 November 2024 with home care arrangements and liberty to move the Court again. After a hospitalisation in May 2025, the parents file the present Miscellaneous Application on 21 October 2025.
- 3Medical boards and familyOn 26 November 2025 the Court directs a primary medical board. On 11 December 2025 it asks AIIMS for a secondary medical board, whose report is dated 17 December 2025. Counsel meet the family, a video conference is held on 8 January 2026, and the Court meets the parents and the younger brother.
- 4JudgmentOn 11 March 2026 Justice Pardiwala delivers the main judgment and Justice Viswanathan delivers a concurring opinion. The Court directs that the treatment, including CANH, be withdrawn and/or withheld and gives nationwide directions.
What Was the Case About?
Harish Rana was a young man of 20, studying for a B.Tech degree at Punjab University, when he fell from the fourth floor of his paying guest accommodation on 20 August 2013 and suffered a diffuse axonal injury. He was treated at PGI Chandigarh and later at the Jai Prakash Narayan Trauma Centre at AIIMS, New Delhi, and other hospitals. Since the accident he has been on a tracheostomy and a urinary catheter and has received CANH, which was first given through a Ryle's tube and then through a surgically placed PEG tube that has to be replaced at a hospital every two months. At the time of the judgment he was 32 years old.
His records show no evidence of awareness of his surroundings and no ability to interact with others. He has sleep-wake cycles, and his eyes open with normal blinks but without purposeful movement or response to sound, speech, touch or painful stimulus. He has been bedridden and has suffered painful bedsores. A disability certificate dated 21 November 2014 describes a head injury with diffuse axonal injury, a vegetative stage, quadriplegia and 100% permanent disability. A certificate dated 13 April 2016 from Dr. Ram Manohar Lohia Hospital describes a persistent vegetative state with complete sensorimotor dysfunction and 100% permanent physical impairment. He was largely cared for at home, and his most recent hospitalisation was in May 2025 at the District Hospital, Ghaziabad, where another tracheostomy was performed.
His family first went to the Delhi High Court under Article 226, seeking a direction to constitute a medical board to examine whether the PEG tube could be withdrawn. On 2 July 2024 the High Court dismissed the writ petition on the ground that he was not being kept alive mechanically and could sustain himself without extra or external medical aid. The Special Leave Petition against that order was disposed of on 8 November 2024 after the Union of India offered home care with support from the Government of Uttar Pradesh, with liberty to the parents to move the Court again if needed. The parents did so by filing the present Miscellaneous Application on 21 October 2025. They asked for the case to be referred to a primary medical board and for a declaration that CANH through a PEG tube is medical treatment. The application did not ask for active euthanasia.
On 26 November 2025 the Court directed that a primary medical board be constituted under the Common Cause guidelines. The Chief Medical Officer of Ghaziabad constituted it with a neurologist, a plastic surgeon, an anaesthesiologist and a neurosurgeon, and it examined Harish at his residence and found that the chances of recovery were negligible. On 11 December 2025 the Court asked AIIMS, New Delhi, to constitute a secondary medical board. Its report dated 17 December 2025 recorded that he has non-progressive, irreversible brain damage, fulfils the criteria of permanent vegetative state and has been in that state for 13 years, and that CANH is required for his survival but may not improve his condition or repair the brain damage. After counsel for both sides met the family, and after a video conference on 8 January 2026 with the Ministry of Health and Family Welfare and doctors of the secondary board, the Court met the father, the mother and the younger brother in person. All three asked that the treatment be discontinued and nature be allowed to take its course.
Ms. Rashmi Nandakumar, for the applicant, submitted that the Common Cause guidelines do not contemplate routine adjudication by courts, but that the family had to come to court because there was no institutional mechanism to start the process for a patient on long-term home care. She argued that CANH is a form of life-sustaining treatment, that the question is not whether it is in the patient's best interest to die but whether it is in his best interest to prolong life artificially, and that the guidelines need to be implemented through directions to States, hospitals and Chief Medical Officers. Ms. Aishwarya Bhati, the learned Additional Solicitor General, submitted for the Union that Common Cause 2018 permits withdrawal of futile treatment, that CANH through medical devices is medical treatment, that its withdrawal is an omission and not causing death, and that the Court may consider permitting withdrawal. She also asked that palliative care be arranged at home or at a hospital of the family's choice.
Issues and What the Supreme Court Held
This table lists the main questions the judgment dealt with, the answer in simple words, and the paragraph of the judgment where you can read it.
| Question | Court's answer | Paragraph |
|---|---|---|
| Is CANH given through a PEG tube medical treatment? | Yes. CANH is a technologically mediated medical intervention that is prescribed, supervised and periodically reviewed by healthcare professionals. It is not mere basic sustenance, and it remains medical treatment when given at home. | Paras 299 to 305, Viswanathan J paras 45 to 49 |
| What does the best interest principle mean? | Not a single rigid test. The right question is whether it is in the patient's best interests that his life be prolonged by the treatment. The Court lists contours, including a strong presumption in favour of life that is not absolute, medical and non-medical considerations, and a balance sheet of benefits and burdens. | Paras 306 to 316, Para 233, Viswanathan J para 58 |
| Was continuing CANH in Harish Rana's best interests? | No. The Court held that the treatment had become prolonged and futile with no hope of recovery, and accepted that had he been competent he would not have chosen to continue CANH. Justice Viswanathan applied his own list of illustrative factors and held that cumulatively they led to the same conclusion. | Paras 234 to 239, Viswanathan J paras 60 to 61 |
| Does the patient have to be terminally ill? | Not necessarily. Justice Viswanathan held that a patient in a permanent vegetative state or a like condition who is undergoing prolonged treatment for an incurable ailment meets the pre-requisites. The main judgment (para 71) lists three prerequisites: the patient is terminally ill, in a PVS or in a like condition; is undergoing prolonged treatment; and the ailment is irreversible, meaning incurable or with no hope of cure. | Para 71, Viswanathan J paras 36 to 44 |
| Is active euthanasia permitted? | No. Active euthanasia involves a positive act that causes death. It remains a penal offence unless Parliament legislates. The application did not ask for it. | Para 293, Para 295, Viswanathan J para 12 |
| Is "passive euthanasia" still the term to use? | Replaced in this judgment. Noting a general consensus that the older term is obsolete and confusing, the Court uses "withdrawing or withholding of medical treatment" in its place in this judgment. It says this is only a change of terminology and the guidelines and safeguards continue to govern. | Para 111 |
| Does a court have to decide every case? | No. If the primary and the secondary medical boards both certify withdrawal or withholding, no court intervention is needed, except in the very limited circumstances the Court describes. The Court explained the law in detail because this is the first case in which the guidelines were applied in their full measure. | Para 240, Para 241, Para 318 |
| What if the patient is treated mostly at home? | Admission to a hospital. The family may admit the patient to a hospital of its choice, and the hospital and its primary treating physician must perform their duties under the guidelines. If that is not feasible, the family may approach a hospital only to designate a primary treating physician. | Paras 265 to 267, Para 322(iii) |
| Who nominates the practitioner on the secondary medical board? | The Chief Medical Officer. The authority to nominate one registered medical practitioner rests with the Chief Medical Officer. CMOs must keep a panel of qualified practitioners and nominate one preferably within 48 hours of a hospital's request, and the panel must be reviewed at intervals not exceeding twelve months. | Paras 268 to 272, Para 322(iv), Para 327(f) |
| What can a family do if the hospital does not start the process? | Approach the High Court. If the treating physician or the hospital does not start the process although the threshold conditions are met, the family may seek directions from the High Court under Article 226. | Para 278, Para 322(v) |
| Is there a waiting period after both boards agree? | Yes, 30 days. Once both boards concur, the decision is implemented only after a reconsideration period of 30 days, during which an aggrieved person who establishes locus may approach the appropriate court. The Court waived it in this case. | Paras 273 to 275, Para 322(vi), Para 327(b) |
| How must withdrawal be carried out? | With palliative care. Withdrawal must be humane and part of a structured palliative and end of life care plan. The Court strongly disapproves of the routine misuse of "discharge against medical advice" in place of such a plan, and says palliative care can be given at home or any place of the family's choice if a plan is prescribed at discharge. | Paras 242 to 253, Paras 319 to 321 |
| What must the family's consent reflect? | What the patient would have wanted. The written consent of the next of kin, next friend or guardian must embody what the patient would have wanted and not the family's own opinion, motive or conviction. The exercise must be patient-centric and not parent-centric. | Paras 262 to 264, Para 322(ii) |
| Did the Court direct comprehensive legislation? | It urged the Union Government to consider it. The Court says its guidelines were never a self-contained or exhaustive code, that the responsibility for a statutory framework rests with Parliament, and urges the Union Government to consider enacting comprehensive legislation. | Paras 279 to 291, Para 323 |
The Court's Reasoning in Simple Words
A Bench of two Judges held that CANH through a PEG tube is medical treatment and that withdrawing it was in Harish Rana's best interests. Justice Pardiwala wrote the main judgment and Justice Viswanathan wrote a concurring opinion. The Court directed withdrawal through a palliative and end of life care plan at AIIMS, waived the 30 day reconsideration period for this case, and directed the High Courts, and the Union of India together with the State and Union Territory Health Secretaries, to take steps so that the Common Cause guidelines work in practice, including panels of practitioners kept by Chief Medical Officers. It urged the Union Government to consider enacting comprehensive legislation.
The Court begins with Common Cause 2018. It explains that active euthanasia means a positive act that causes death, while withdrawing or withholding medical treatment means allowing death to occur from the underlying condition. It says the line should not rest only on the difference between acts and omissions. It records that Common Cause 2018 held withdrawal or withholding of medical treatment to be permissible under Article 21 if it is in the patient's best interests, and that active euthanasia remains a penal offence unless Parliament legislates. The Court also notes a general consensus that 'passive euthanasia' is an obsolete and confusing term. To ensure clarity in this judgment, it uses 'euthanasia' only for active euthanasia, which remains impermissible, and uses 'withdrawing or withholding of medical treatment' in place of 'passive euthanasia'. It adds that this is a change of terminology and not of substance, so the guidelines and safeguards of Common Cause 2018 continue to govern.
The first question is whether CANH is medical treatment. The Court holds that it is. It points out that prescribing and giving CANH involves clinical decisions such as installing the device, assessing nutritional needs and the risks of complications, and periodic medical review. It holds that CANH is a technologically mediated medical intervention and not mere basic sustenance, and that it remains medical treatment even when it is given at home, because it needs regular medical and nursing supervision. As a result, the primary and secondary medical boards may exercise their clinical judgment on continuing, withdrawing or withholding CANH, as with any other medical treatment, in accordance with the Common Cause guidelines.
The second question is what the best interest principle means. The Court says it applies when treatment is to be withdrawn or withheld for a patient who cannot decide for himself, and that every decision-maker must follow it, including the medical boards, the next of kin, next friend or guardian, and the courts. The right question is whether it is in the patient's best interests that his life be prolonged by continuing the treatment, and not whether it is in his best interests to die. It is not a narrow or rigid test. It starts from a strong presumption in favour of preserving life, which can be displaced where treatment stops serving any therapeutic purpose, merely prolongs suffering without hope of recovery, or causes indignity. Decision-makers must weigh medical considerations and non-medical considerations, which include what the patient would have wanted if he had capacity, and they must not substitute their own wishes. This substituted judgment standard is a strong element of the best interest principle but does not override it. Finally, they draw a balance sheet that weighs the benefits of continued treatment against its burdens.
Applying these principles, the Court records that the two medical boards and the next of kin had considered the medical and non-medical aspects and had concluded that CANH should be discontinued. It finds that the treatment has become prolonged and futile and offers no hope of recovery. It notes that there is no material on record about any wishes Harish expressed earlier, but it looks at his life before the injury, when he was physically active and keen on gymming and football, and accepts that had he been competent today he would not have chosen to continue CANH. It adds that this discussion does not mean that a court must always decide what is in a patient's best interest. If both medical boards certify withdrawal or withholding, no court intervention is needed, except in the very limited circumstances it describes. It explains that it went into the legal framework because this is the first case to reach it in which the Common Cause guidelines are applied in their full measure.
The Court then deals with how withdrawal must be carried out. It says withdrawal must be humane and must not become abandonment of the patient. It must be a transition from curative treatment to a structured, medically supervised palliative and end of life care plan aimed at relieving pain and distress and preserving dignity. The Court strongly disapproves of the routine misuse of 'discharge against medical advice' in place of such a plan. It says palliative care need not always be given in a hospital, and can be given at home or any place the family chooses, as long as a palliative and end of life care plan is prescribed at the time of discharge. It also says hospitals may legally admit patients who are being treated at home so that the best interest assessment can be done, and that hospitals and doctors should not hesitate to do so.
The Court then explains and streamlines the Common Cause guidelines. It says that safeguards at each stage are meant to remove hesitation among doctors. The written consent of the next of kin, next friend or guardian is integral, and it must reflect what the patient would have wanted and not what the family wants. For a patient treated mostly at home, the family may admit him to a hospital of its choice, or approach a hospital only to designate a primary treating physician, who then starts the process. Chief Medical Officers must keep a panel of qualified registered medical practitioners and nominate one preferably within 48 hours of a hospital's request. If the treating physician or hospital fails to start the process despite the conditions being met, the family may seek directions from the High Court under Article 226. Once both boards agree, the decision is implemented only after a reconsideration period of 30 days, during which an aggrieved person with locus may approach the appropriate court, and courts must exercise restraint before unsettling the process.
On legislation, the Court says the field remains largely unregulated, that its guidelines were never meant to be a self-contained or exhaustive code, and that the responsibility for a comprehensive law rests with Parliament. It urges the Union Government to consider enacting comprehensive legislation in line with the vision of the Bench in Common Cause.
Justice Viswanathan agreed with Justice Pardiwala and wrote separately. He held that the High Court was wrong to reject the case on the ground that Harish was not terminally ill. In his view, for a primary and then a secondary medical board to be constituted, the patient need not be terminally ill, and a patient in a permanent vegetative state or a like condition, who is undergoing prolonged treatment for an incurable ailment or where there is no hope of cure, meets the pre-requisites. He held that feeding tubes are medical treatment and listed illustrative factors for the best interest test. He applied them to the medical reports, the family's views and the indignity Harish faces, and held that cumulatively they led to the conclusion that continuing the treatment was not in his best interests. In a postscript he says that his judgment does not rest on the relief the family will feel once the order is carried out, and that it rests on the applicable legal principles and Harish's best interest.
- The Court did not permit active euthanasia or assisted dying. The application did not ask for it, and active euthanasia remains impermissible in the absence of legislation.
- The Court did not enact a law. It urged the Union Government to consider enacting comprehensive legislation and said its guidelines were never meant to be a permanent substitute.
- The Court did not lay down one fixed test for best interests. It says the principle is not a narrow, rigid or formulaic test and lists considerations that may include but are not limited to its own list.
- The Court did not hold that a court must decide every case. It says no court intervention is needed if both medical boards certify withdrawal or withholding, except in the very limited circumstances it describes.
- This is a case with no advance medical directive. The Court summarised what Common Cause 2018 says about advance medical directives, but Harish Rana made none, and the Court records that there is no material on record about any wishes he expressed earlier.
- In a postscript, Justice Viswanathan says his judgment does not rest on the relief the family will feel once the order is carried out. It rests on the applicable legal principles and Harish Rana's best interest.
Who Wrote What: Two Judges, Two Opinions
The Bench of two Judges delivered two opinions. The table shows what each opinion says and the PDF pages where it sits.
| Judge or Judges | What the opinion says | PDF pages |
|---|---|---|
| Justice J.B. Pardiwala | The main judgment, divided into Parts A to G. It sets out the facts and submissions, explains the core concepts of Common Cause 2018, holds that CANH is medical treatment, explains the best interest principle with comparative law, applies it to Harish Rana, deals with palliative and end of life care, streamlines the Common Cause guidelines, urges legislation, and gives the Final Order with directions. | Pages 2 to 287, Final Order, pages 282 to 287 |
| Justice K.V. Viswanathan | A separate concurring opinion that agrees with the main judgment. It holds that a patient need not be terminally ill for the medical boards to be constituted, that feeding tubes are medical treatment, lists illustrative factors for the best interest test, applies them to Harish Rana, and allows the application in terms of the directions in Justice Pardiwala's judgment. It ends with a postscript. | Pages 288 to 338, Conclusion, pages 336 to 338 |
Final Order of the Supreme Court
- The medical treatment, including CANH, being administered to the applicant shall be withdrawn and/or withheld.
- In the peculiar facts of this case, the reconsideration period of 30 days is waived, because all stakeholders are unanimous that the treatment be withdrawn and/or withheld.
- AIIMS, the second respondent, shall admit the applicant to its Palliative Care department and provide all necessary facilities for shifting him from his residence to that department.
- AIIMS shall ensure that the withdrawal and/or withholding is carried out through a robust palliative and end of life care plan, specifically tailored to manage symptoms without causing any discomfort and to preserve his dignity to the highest degree.
- The High Courts of all States shall issue appropriate directions to all Judicial Magistrates of First Class within their jurisdiction to receive intimation from the hospital, as the Common Cause guidelines require, when the primary and secondary medical boards are unanimous in their decision to withdraw and/or withhold medical treatment of any patient.
- The Union of India, in coordination with the Secretaries of Health and Family Welfare of all States and Union Territories, shall ensure that the Chief Medical Officers of all concerned districts forthwith prepare and maintain a panel of registered medical practitioners with the qualifications required by the Common Cause guidelines, for nomination to the secondary medical board. The panel must be reviewed and updated at intervals not exceeding twelve months, and the State and Union Territory Secretaries must make sure this is done.
- The Registry shall list the matter before the same Bench after one month to report compliance with the first five directions above, and sometime in August 2026 to report compliance with the direction on the panels of the Chief Medical Officers.
- The Registry shall send one copy of the judgments to all the High Courts.
Laws, Rules and Cases in This Judgment
| Provision | What it deals with and how it features | Paragraph |
|---|---|---|
| Article 21 of the Constitution | The right to life with dignity, which Common Cause 2018 held includes the right to die with dignity. The Court says withdrawing or withholding medical treatment in the patient's best interests is permissible under it. | Para 294, Viswanathan J paras 33 to 34 |
| Article 226 of the Constitution | The High Court's writ jurisdiction. The Common Cause guidelines allow an approach to the High Court where a medical board does not agree, and the Court adds that a family may approach it if the physician or hospital fails to start the process. | Paras 259 to 260, Para 278 |
| Common Cause guidelines, para 199, read with paras 198.4.4 and 198.4.5 | The procedure for patients without an advance medical directive, with a primary medical board, a secondary medical board and intimation to the Judicial Magistrate of First Class. The guidelines as modified in 2023 ask both boards to certify preferably within 48 hours. | Paras 255 to 256, Paras 270 to 271, Viswanathan J paras 16 to 17 |
| Law Commission of India, 196th and 241st Reports | Two reports that examined the subject. The Court notes that, along with private members' bills, they did not generate sustained legislative deliberation. The 241st Report is also discussed in the best interest analysis. | Para 280, Viswanathan J paras 50 to 51 |
| ICMR Palliative and End of Life Care Primer, 2018 | Guidance on the duty of a health care provider to relieve suffering, including in the dying phase. The Court finds it apposite to refer to it. | Paras 247 to 248 |
| Palliative Care Operational Guidelines, 2017 | Issued under the National Programme for Palliative Care by the Directorate General of Health Services. The Court notes that the goals of palliative care include relief from pain and distress and that it does not intend to hasten or postpone death. | Para 249 |
| ISCCM and IAPC Position Statement, 2024 | Identifies barriers to end of life care in India, including concerns about the legality of withdrawing or withholding treatment. The Court notes that a palliative care plan should be in place when withdrawal is implemented. | Para 250 |
| AIIMS Guidelines for End of Life Care | Provide guidance on documentation during end of life care, including a daily supportive care plan that is reviewed daily by a doctor trained in end of life care. | Para 251 |
| Case | How it features | Paragraph |
|---|---|---|
| Common Cause vs Union of India, (2018) 5 SCC 1 | Five-Judge Constitution Bench decision on which the whole judgment rests. It permits withdrawing or withholding of medical treatment in the best interests of the patient and lays down the procedure. | Para 5, Paras 26 to 27, Paras 293 to 298 |
| Common Cause vs Union of India, (2023) 14 SCC 131 | Modified the 2018 guidelines. The Court notes that it asked both boards to certify preferably within 48 hours and aimed at minimal judicial intervention. | Para 5, Para 270, Para 276 |
| Airedale NHS Trust vs Bland, 1993 AC 799 | House of Lords decision. Lord Keith said regard must be had to the whole regime of artificial feeding, and Lord Goff compared artificial feeding to a ventilator. Justice Viswanathan relies on it, and the Court adopts the same view of the whole regime of artificial feeding. | Para 302, Viswanathan J para 48 |
| Aruna Ramachandra Shanbaug vs Union of India, (2011) 4 SCC 454 | Justice Viswanathan records the submission that it concerned a patient in a permanent vegetative state and not a terminally ill person. Justice Pardiwala notes that it laid down guidelines permitting withdrawal or withholding of treatment for patients with terminal illness undergoing prolonged and futile treatment. | Para 282, Viswanathan J paras 38 to 39 |
| Gian Kaur vs State of Punjab, (1996) 2 SCC 648 | Relied on in Common Cause 2018 for the view that life under Article 21 means life with human dignity and includes the right to die with dignity. | Viswanathan J para 33 |
| Vacco vs Quill, 138 L.Ed. 2d 834 | A US decision. Common Cause 2018, as recorded by Justice Viswanathan, relied on this US decision for the view that when a patient dies after life-supporting measures are removed, the patient dies of an underlying fatal disease without any intervening act on the part of the doctor. | Viswanathan J para 31 |
| Aintree University Hospitals NHS Foundation Trust vs James, 2013 UKSC 67 | UK Supreme Court decision quoted for the view that decision-makers must look at the patient's welfare in the widest sense, not just medical but also social and psychological. | Viswanathan J para 55 |
| NHS Windsor and Maidenhead Clinical Commissioning Group vs SP, 2018 EWCOP 11 | Court of Protection decision quoted on the balancing exercise, including that there is a strong presumption for the prolongation of life that is not absolute. | Viswanathan J para 56 |
| Hillingdon Hospitals NHS Foundation Trust vs IN, [2023] EWCOP 32 | Court of Protection decision relied on to say that withdrawal of CANH must follow a step by step withdrawal plan. | Para 245 |
| NHS South East London Integrated Care Board vs JP, [2025] EWCOP 4 (T3) | Court of Protection decision quoted by Justice Viswanathan on CANH as a futile treatment and on the family as the conduit for the patient's views. | Viswanathan J para 57 |
Key Points From This Judgment
- CANH given through a PEG tube is medical treatment, even when it is given at home, and the medical boards may exercise their clinical judgment on continuing or withdrawing it, as with any other medical treatment, in accordance with the Common Cause guidelines.
- Withdrawing or withholding medical treatment is permitted under Article 21 when it is in the patient's best interests. For a patient who cannot decide for himself, this applies once the threshold conditions are met and the Common Cause process is followed. The Court uses this phrase in place of 'passive euthanasia' in this judgment. Active euthanasia remains impermissible without legislation.
- The best interest test asks whether it is in the patient's best interests that his life be prolonged by continuing the treatment, and it weighs medical and non-medical considerations through a balance sheet.
- If the primary and secondary medical boards both certify withdrawal or withholding, no court intervention is needed, except in the very limited circumstances the Court describes.
- Justice Viswanathan held that the patient need not be terminally ill, and that a patient in a permanent vegetative state or a like condition who is undergoing prolonged treatment for an incurable ailment meets the pre-requisites. The main judgment (para 71) lists terminal illness, PVS or like conditions as alternatives.
- Withdrawal must follow a palliative and end of life care plan. The Court strongly disapproves of using 'discharge against medical advice' in its place.
- A patient treated mostly at home can start the process through admission to a hospital of the family's choice, or by approaching a hospital to designate a primary treating physician.
- Chief Medical Officers across the country must maintain a panel of registered medical practitioners and nominate one preferably within 48 hours of a hospital's request, and High Courts must direct Judicial Magistrates to receive intimations from hospitals.
- A reconsideration period of 30 days follows the concurrence of both boards, and the Court waived it in this case.
- The Court urges the Union Government to consider enacting comprehensive legislation on the subject.
Why This Judgment Matters
This is the first case to reach the Supreme Court in which the Common Cause guidelines were applied in their full measure, and the Court used it to clarify practical questions that doctors, hospitals and families face. The Court held that CANH is medical treatment, spelled out the best interest test, explained how the process works for patients on home care, and gave directions to AIIMS, the High Courts, the Union of India and the States. It did not allow active euthanasia, and it urged the Union Government to consider enacting a comprehensive law. It is a Reportable judgment of a Bench of two Judges, so lawyers should read the Final Order and the concurring opinion of Justice Viswanathan together with the main judgment.
This page is useful for lawyers, judges, doctors, hospital administrators, law students and families who want to understand how the Supreme Court explained the withdrawal of medical treatment in the Harish Rana case.
Key Legal Terms Explained
- CANH
- Clinically Assisted Nutrition and Hydration, which is nutrition and fluids given through a medical device such as a feeding tube.
- PEG tube
- A Percutaneous Endoscopic Gastrostomy tube, a surgically placed feeding tube.
- Permanent vegetative state (PVS)
- A condition in which the patient shows no awareness of himself or his surroundings and cannot interact with others, but has sleep-wake cycles. The documents in this case use both the words persistent and permanent.
- Primary medical board
- The first board under the Common Cause guidelines. It is formed by the hospital, includes the treating physician and subject experts, and certifies the course of action after discussing it with the family.
- Secondary medical board
- The second board, which includes one registered medical practitioner nominated by the Chief Medical Officer and subject experts who were not on the primary board. It may concur with the primary board.
- Best interests
- The principle that decides whether treatment should be continued, withdrawn or withheld for a patient who cannot decide for himself.
- Substituted judgment
- Deciding on the basis of what the patient himself would have decided had he possessed the capacity to decide.
- Next of kin, next friend or guardian
- The persons who speak for a patient who cannot decide for himself and whose written consent the process needs.
- Chief Medical Officer (CMO)
- The Chief Medical Officer of the district, who nominates a registered medical practitioner to the secondary medical board.
- Advance medical directive (AMD)
- A document in which a person records in advance whether treatment may be refused if he later loses capacity. None existed in this case.
- Palliative and end of life care
- Medically supervised care that shifts the focus from cure to relief of pain and distress and preservation of dignity.
Read the Full Judgment
Read every paragraph and the final order on the official Supreme Court of India website.
This page explains the judgment in simple words. It is not legal advice. Please read the full judgment before you rely on it.
Frequently Asked Questions
What is the Harish Rana case about?
It is about whether medical treatment can be withdrawn from a young man who has been in a permanent vegetative state for 13 years after a fall in August 2013. His parents asked the Supreme Court to apply the Common Cause guidelines and to declare that CANH through a PEG tube is medical treatment.
What did the Supreme Court decide in Harish Rana vs Union of India?
The Court held that CANH is medical treatment and that its continuation was not in Harish Rana's best interests. It directed that his medical treatment, including CANH, be withdrawn and/or withheld through a palliative and end of life care plan at AIIMS, New Delhi.
What is CANH?
CANH stands for Clinically Assisted Nutrition and Hydration. In this case it was given through a Percutaneous Endoscopic Gastrostomy (PEG) tube, which was placed surgically and is replaced at a hospital every two months.
Is passive euthanasia legal in India after this judgment?
Withdrawing or withholding medical treatment is permitted under Article 21 when it is in the patient's best interests and the conditions and safeguards of Common Cause 2018 are met. The Court notes a general consensus that "passive euthanasia" is an obsolete and confusing term and uses "withdrawing or withholding of medical treatment" in its place in this judgment. It says this is only a change of terminology. Active euthanasia remains impermissible.
What is the best interest test?
The right question is whether it is in the patient's best interests that his life be prolonged by continuing the medical treatment, and not whether it is in his best interests to die. The Court says decision-makers must weigh medical and non-medical considerations, including what the patient would have wanted, and draw a balance sheet of the benefits and burdens of continued treatment.
Does a court have to approve every withdrawal of treatment?
No. The Court says that if the primary and the secondary medical boards both certify the withdrawal or withholding of treatment, no court intervention is needed, except in the very limited circumstances it describes.
Does the patient have to be terminally ill?
Justice Viswanathan held that the patient need not be terminally ill. In his view, a patient in a permanent vegetative state or a like condition, who is undergoing prolonged treatment for an incurable ailment or where there is no hope of cure, satisfies the pre-requisites for constituting the medical boards. The main judgment (para 71) lists terminal illness, PVS or like conditions as alternatives, and does not address the point separately.
Who sits on the primary and secondary medical boards?
Under the Common Cause guidelines, the primary medical board has the treating physician and at least two subject experts with at least five years' experience. The secondary medical board has one registered medical practitioner nominated by the Chief Medical Officer of the district and at least two subject experts with at least five years' experience, who were not part of the primary board.
What is the reconsideration period?
It is a period of 30 days after both medical boards agree to withdraw or withhold treatment. During it, an aggrieved person who can establish locus may approach the appropriate court. The Court waived it in this case because all stakeholders were unanimous.
What did the Court direct AIIMS to do?
AIIMS must admit Harish Rana to its Palliative Care department, provide all facilities for shifting him from his residence, and carry out the withdrawal through a robust palliative and end of life care plan that manages symptoms without discomfort and preserves his dignity.
What did the Court direct for the whole country?
High Courts must direct Judicial Magistrates of First Class to receive intimations from hospitals. The Union of India and the State and Union Territory Health Secretaries must ensure that Chief Medical Officers prepare and maintain a panel of registered medical practitioners, reviewed at intervals not exceeding twelve months, for nomination to the secondary medical board.
Can a family of a patient who is treated at home use this process?
Yes. The Court says the family may admit the patient to a hospital of its choice, and that hospital and its primary treating physician must perform the duties under the guidelines. If admission is not feasible, the family may approach any hospital only to designate a primary treating physician, who then starts the process.
What can a family do if the hospital does not start the process?
If the treating physician or the hospital fails to start the process although the threshold conditions or medical parameters are met, the next of kin, next friend or guardian may seek directions from the High Court under Article 226 of the Constitution.
Is "discharge against medical advice" an acceptable way to withdraw treatment?
Not in place of a structured palliative and end of life care plan. The Court strongly disapproves of its routine misuse where treatment has been discontinued, and says the choice to withdraw or withhold treatment does not mean the patient loses the right to medically supervised care.
Did the Court ask for a new law?
It urged the Union Government to consider enacting comprehensive legislation on the subject, in line with the vision of the Bench in Common Cause 2018, and said the responsibility for a statutory framework rests with Parliament.
Who wrote the Harish Rana judgment?
Justice J.B. Pardiwala wrote the main judgment, and Justice K.V. Viswanathan wrote a separate concurring opinion. The Bench agreed that the application be allowed in terms of the directions in Justice Pardiwala's judgment.
Where can I read the full Harish Rana judgment?
You can read it on the official Supreme Court of India website through the judgment PDF linked on this page. Its neutral citation is 2026 INSC 222 and the diary number is 60980/2025.
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